How to manage children who aspirate and fail conventional treatments

Abstract Dysphagia is a growing problem among premature and medically complicated infants and children. In 2020, Lawlor et al. published a comprehensive review of the diagnosis and management of children with dysphagia. We wanted to expand on this review by describing what happens to children whose dysphagia does not improve by routine management. Our introduction describes what we know about pediatric dysphagia, and what questions families ask us (and we ask ourselves) when children do not respond to conventional medical treatments. We then describe three cases of dysphagia as diagnostic dilemmas and highlight the importance of a multi-disciplinary approach to manage these children and answering these questions. We incorporate clinical reasoning from our own aerodigestive team (otolaryngology, pediatric pulmonary and pediatric gastro enterology) as well as from experts in pediatric general surgery and neurosurgery to describe our approach to diagnosing and managing these children.